mark klimek, Mark Klimek, Mark Klimek Lecture Outline NCLEX, Mark Klimek, Mark Klimek NCLEX Pharm, mark klimek review tips with Complete Solutions(GRADED A+)

Rule of B's for ABGs - ANSWER-if the pH and the Bicarb are Both in the same direction it is metaBolic normal pH normal Bicarb - ANSWER-pH: 7.35-7.45 Bicarb: 22-26 Kussmul respirations - ANSWER-MACkussmul= metabolic acidosis S&S of acid-base imbalance - ANSWER-as the pH goes, so goes my patient except for potassium UP: (alkolosis):decreased K+, highest risk for seizures DOWN: (acidosis): increased K+, highest risk for respiratory arrest causes of respiratory acid-base imbalance - ANSWER-lung=respiratory overvent or undervent overvent= alkolosis undervent=acidosis causes of metabolic acid-base imbalance - ANSWER-not lung=metabolic prolonged gastric vomiting or suction=metabolic alkolosis (losing acid) everything else=metabolic acidosis high pressured ventilator alarms - ANSWER-triggered by increase resistance to air flow and can be caused by obstruction of three types: kinked tube: unkink it water in tube: empty it mucus in airway: turn, cough, deep breathe low pressured ventilator alarams - ANSWER-triggered by decreased resistance to air flow and can be caused by disconnections: tubing: reconnect if not contaminate if contaminated (below bed level): call first, then bag, reconnect respiratory alkalosis vs acidosis - ANSWER-alkalosis: ventilator setting may be too high (overvent) acidosis: ventilator setting may too low (undervent) HOLD - ANSWER-high pressured alarms obstruction low pressured alarms disconnection Maslow - ANSWER-1. physiological 2. safety 3. comfort 4. psychological 5. social 6. spiritual #1 problem in substance abuse - ANSWER-denial: refusal to accept the reality of their problem treatment: confront it by pointing out to the person the difference between what they say and what they do. however, in grief and loss support denial dependency/codependency - ANSWER-dependency: when abuser gets SO to do things for them or make decisions for them codependency: when the SO derives positive self-esteem from doing things for or making decisions for the abuser treating dependency/codenpendency - ANSWER-set limits and enforce them. agree in advance what requests are allowed then enforce the agreement work on the self-esteem of the codependent person manipulation - ANSWER-when abuser gets the SO to do things for him/her that are no in the best interest of the SO. nature of the act is dangerous or harmful to SO treatment of manipulation - ANSWER-set limits and enforce them easier to treat than dependency/codependency because no body likes being manipulated wenicke's korsakoff syndrome - ANSWER-psychosis caused by a lack of B1 (thiamine) deficiency primary symptom: amnesia with confabulation -preventable -arrestable -irreversible antabuse/revia (disulfiram) - ANSWER-aversion therapy onset/duration of effectiveness: 2 weeks pt teaching: avoid all forms of alcohol to avoid nausea, vomiting, death uppers - ANSWER-cocaine, caffeine, PCP/LSD, methamphedimines, ADHD meds (amphetimines), bath salts S&S: increase everything, pupils dilate (mydriasis), seizures downers - ANSWER-codeine, heroin, alcohol, marijuana S&S: decrease everything, pupils constrict (miosis), respiratory arrest overdose vs withdrawal - ANSWER-upper overdose: everything is high upper withdrawal: everything is low downer overdose: everything is low downer withdrawal: everything is high alcohol withdrawal syndrome vs delirium tremens - ANSWER-every alcoholic go through AWS (24 hrs) only a minority get DT (usually 72 hrs) AWS is not life-threatening. DT can kill you PT with AWS are not dangerous to themselves or others. PTs with DT's are dangerous to self and others pg 8 aminoglycosides (a mean old mycin) - ANSWER-antibiotics to treat serious, life-threatening, resistant all end in -mycin/micin, but not all drugs that end in -mycin/micin are "a mean old mycin" (all have thro in them and are opposites of aminoglycosides) toxic effects of "a mean old mycin" - ANSWER-think of mice (ears) ototoxicity must monitor balance, tinitus, hearing (most important) ear is shaped like a kidney nephrotoxicity monitor creatinine (best indicator of kidney fx) #8 drawn inside the ear reminds you cranial nerve 8 frequency of administration: q8h route of administration for "a mean old mycin" - ANSWER-give IV or IM do not give PO (not absorbed) except in tow cases: sterilize the bowel -> neonmycin/canmycin hepatic encephalopathy also called liver coma, ammonia-induced encephalopathy, due to a high ammonia level pre-op bowel surgery remember this military sound-off Q: who can sterile my bowel? A: Neo-can through and peak levels for amonoglycin - ANSWER-reasons for drawing TAP levels: narrow therapuetic range pg 10 category A bioterrorism - ANSWER-can hurt people worst S: small pox T: tularemia A: anthrax P: plague H: hemorrhagic fever B: botulism category C bioterrorism - ANSWER-nipen virus harita virus small pox - ANSWER-person to person inhaled transmission/on airborne precautions dies from septicemia. no treatment rash starts around mouth first-> early finding then quarentine tularemia - ANSWER-inhaled, not passed person to person chest symptoms dies from respiratory failure treat with streptomycin anthrax - ANSWER-spread by inhalation, not person to person looks like respiratory flu=chest symptoms dies from respiratory failure treat with cipro, pcn and streptomycin plague - ANSWER-spread by inhalation, not person to person has the 3 H's -hemoplysis: coughing blood -hematemesis: puking blood -hematochezia: bloody diarrhea dies from respiratory failure and DIC (treat with heparin) treat with doxycycline and mycins no longer communicable after 48 hours of treatment hemorrhagic illnesses - ANSWER-inhalation primary symptoms are petechiae (red spots) and ecchymoses high % fatal botulism - ANSWER-ingested 3 major symptoms: -descending paralysis -fever -but is alert dies from respiratory failure kids: trach, intabate, coma chemical agents - ANSWER-mustard gas: blister cynaide: resp arrest, treat with sodium thiosulfate IV phosgine chlorine: choking sarin: nerve agent. symptoms (cholenergenic crisis): -Bronchorrhea: huge resp mucus -Bronchoconstriction -Salavation (excessive) -Lacarmating (tears) -Urinating (polyuria) -Diarrhea/diaphoresis -GI upset -Emesis pg 13 calcium channel blockers - ANSWER-negative ino, chorno, dromo weak, slow, blocks/slow conduction Ca+ channel blockers treat - ANSWER-antihypertensives: decrease BP Anti Anginals: treat angina- decrease O2 demand Anti Atrial Arrhythemias: "supraventricular" side effects: headache, hypotension, bradycardia names of Ca+ channel blockers - ANSWER-isoptin, -zem, -dipine (i saw them dippin the calcium channel" cardiac arrhythmias terminology - ANSWER-QRS depolarization always refers to mark klimek, Mark Klimek, Mark Klimek Lecture Outline NCLEX, Mark Klimek, Mark Klimek NCLEX Pharm, mark klimek review tips with Complete Solutions(GRADED A+)